Provider Demographics
NPI:1144183989
Name:RILEY, EDDIE LUDDEN (MED, MED)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:LUDDEN
Last Name:RILEY
Suffix:
Gender:M
Credentials:MED, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 OLD BOALSBURG RD
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6150
Mailing Address - Country:US
Mailing Address - Phone:814-237-0001
Mailing Address - Fax:
Practice Address - Street 1:1951 PINE HALL RD
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5106
Practice Address - Country:US
Practice Address - Phone:814-237-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-08
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health